We’ve all been to the doctor and been told our cholesterol is too high. For years a good cholesterol was considered anything below 220, then it was 200, and now it’s less than 200. The bar seems to be changing as doctors learn more about the science of good and bad cholesterol.

We’ve been told for a long time that LDL (low density lipoproteins) are “bad cholesterol” and HDL (high density lipoproteins) are “good cholesterol.” A blood test showing our HDLs are high and our LDLs are low has always been considered ideal. But all that seems to be under scrutiny as new information becomes available.

Jennifer Sweenie, writing for The Epoch Times, tells us emerging research is painting a new picture: Focusing solely on “bad” cholesterol misses pivotal pieces of the puzzle. Factors such as the size and composition of particles of high-density lipoprotein (HDL) cholesterol—the so-called good cholesterol—along with triglyceride levels and overall metabolic health, are equally, if not more, important in preventing heart disease. This new understanding is reshaping how we assess heart health, shifting the lens to a more comprehensive, preventive, and personalized approach that prioritizes lifestyle changes such as diet and exercise,

Cholesterol is a fat-associated substance essential for building healthy cells and producing vital hormones such as vitamin D. It’s not inherently bad. Your liver produces most of the cholesterol circulating in your body. The real issue lies in how cholesterol is transported.

“Your liver makes most of the cholesterol that’s circulating around, and your body’s pretty good at maintaining a homeostasis, “ said Nick Norwitz, a Harvard medical student and Ph.D. in physiology from Oxford University.. ”So if you eat more cholesterol, your liver makes less. If you eat less cholesterol, your liver makes more.”

Since cholesterol doesn’t dissolve in blood, it’s transported by lipoproteins, which resemble tiny “delivery buses” on the highway of your bloodstream. LDL primarily carries cholesterol to cells, and excess LDL—especially small, dense particles—can contribute to plaque buildup. HDL helps remove excess cholesterol from the bloodstream and returns it to the liver. In short, cholesterol is the cargo, and LDL and HDL are the vehicles that transport the cargo.

LDL gets its reputation as bad cholesterol because excess amounts can contribute to plaque buildup in the arteries. These smaller particles are more likely to damage the artery wall and cause inflammation. Davis compared them to tiny buses that zip in and out of traffic, increasing the chance of crashes. These “crashes” represent inflammation, which can lead to “traffic jams” or plaque accumulation.

Conversely, larger, “fluffy” LDL particles are less likely to cause problems. HDL helps clear excess cholesterol from the bloodstream and transport it back to the liver for disposal, reducing the risk of buildup. In other words, the real concern lies in how LDL and HDL behave. It’s not the cholesterol itself but the actions of its carriers that can yield plaque buildup.

For years, we’ve been told that lowering LDL cholesterol is the primary way to protect our hearts, but the reality is more nuanced. While elevated LDL can contribute to risk, its impact is conditional, as it’s inextricably linked to overall metabolic health and other factors.

One factor is the amount of apolipoprotein B (ApoB) in your blood, a protein that transports cholesterol and other fats. This can be measured with the ApoB test. “The risk associated with ApoB and LDL counts is context-dependent,” Norwitz said. This context involves an intricate interaction of lipids, metabolic factors, and lifestyle.

Without getting too much farther into the weeds with this discussion, the point is we have more to learn about cholesterol and our current way of measuring good and bad cholesterol is probably inadequate. Stay tuned for more as we learn how we can live longer through a balance of exercise, sleep, and stress management along with controlling our cholesterol levels, good and bad.

You can’t believe everything you read. That’s a simple statement we all need to be reminded of when reading anything in the media. I was reminded of that recently while reviewing an article published in The Epoch Times.

Author George Citroner leads his article with these words: “Patients who undergo anterior cruciate ligament reconstruction (ACLR) surgery to repair torn ligaments may be at an elevated risk of developing early-onset knee arthritis, particularly because of issues related to the kneecap, according to a new study.”

According to the study, findings show that those who received ACLR surgery had a shift in the positions of their knee bones and joints, causing a change in load on their knees. ACLR surgery, common among athletes, aims to repair torn ligaments—but has also been linked to long-term complications, with more than 50 percent of patients developing arthritis within 20 years.

The study, recently published in the Journal of Orthopaedic Research, included 15 participants around the age of 26 years who had undergone ACLR, and compared their knee movements with those of 10 people with no knee problems. The kneecap, or patella, in those who had surgery moved up by 4.4 to 5.6 millimeters more than the nonsurgical group’s kneecaps, and this changed the way the knee joint moved. The patella was also pushed forward by 5.4 to 6.3 millimeters more during walking, indicating a change in knee structure that could stress the joint. The study also noted that the tendon connecting the knee cap to the shinbone was an average of 8.9 millimeters longer in ACLR patients than in the healthy group.

Among the ACLR participants, nearly half had an abnormally higher knee cap, also known as patella alta, which may put excessive stress on parts of the knee that are not used to handling load. According to researchers, a higher-riding patella may contribute to the development of knee osteoarthritis by shifting the load-bearing areas between the patella and the femur to regions of cartilage unaccustomed to load and leaving previously loaded regions unloaded.

“If this condition existed prior to the injury, then it may be a predisposing factor for ACL injury,” corresponding author Marcus G. Pandy, of the University of Melbourne in Australia, told The Epoch Times. “Alternatively, if the condition arose as a result of surgery, then it may help to explain the high rate of knee osteoarthritis seen after ACLR.” According to Pandy, the key takeaway is that people who have undergone ACLR have an abnormally longer tendon in their knees, causing a higher-than-normal kneecap position.

What’s wrong with this study?

Dr. James Penna, chair of the Department of Orthopaedics and Rehabilitation at Stony Brook Medicine, disagreed that ACLR surgeries could be causing a longer knee tendon. The angle of the knee upon impact with the ground varies between individuals who have had an ACL injury and those who haven’t, Penna said.

The researchers who conducted the study raised the question about whether it’s the injury or reconstruction that can lead to elongation of the patellar tendons. Penna disagreed that the longer tendon in the knee could be caused by the surgery. “It doesn’t, it can’t,” he said. He believes the researchers simply happened to have patients with naturally longer tendons in their sample.

Pandy and team wrote that further research is needed to determine the cause of the longer knee tendon in individuals who have undergone ACLR surgery. The researchers didn’t compare those who received ACLR surgery with those who didn’t—this would be the next step, according to Pandy.

My Opinion

It has been well known for nearly fifty years that individuals who sustain ACL injuries are susceptible to developing post-traumatic arthritis in that knee for multiple reasons. The rupture of the anterior cruciate ligament (ACL) is a significant trauma to the knee and is usually associated with other injuries such as a torn medial and or lateral meniscus, collateral ligament injuries, as well as articular cartilage damage. Such injuries will lead to traumatic arthritis in most patients whether or not they ever have ACL reconstructive surgery.

The premise of the Pandy team study that ACL reconstructive surgery leads to alteration of the length of the patella tendon is not credible. Although there are several different methods used for ACL reconstruction, I know of no methods that alter the pre-injury length of the tendon. That means the observation in their study that patients with longer tendons were more likely to develop arthritis is simply an indication that those individuals were at higher risk for developing arthritis, regardless of whether or not they had ACL reconstruction.

The limited size of their study, only 15 patients, means little can be learned from the results of such a study. The only possible conclusion of this study is that patients with longer patella tendons may possibly be more vulnerable to sustaining ACL injuries that those with normal length patella tendons. However, a much larger study group would be needed to draw any meaningful conclusions.

If you are facing ACL surgery, the main thing you should realize is that you are at higher risk of developing traumatic arthritis than individuals without ACL injuries. The surgery is done to stabilize your knee, which should reduce, but not eliminate, your risk of developing arthritis.

In Parts I and II of this series, I have tried to explain some of the problems with Medicaid. This is significant for two reasons:

First, the amount of taxpayers’ money being spent on Medicaid has been skyrocketing lately to the point where Medicaid spending was $894 Billion in 2024, exceeding the Defense Department spending of $841 Billion. It has grown from about $402 Billion in 2010, more than doubling in just 15 years.

Second, as the new Department of Government Efficiency (DOGE) tries to cut waste, fraud, and abuse in our federal government, no one should be fooled into thinking that cuts in Medicaid spending are going to adversely impact the health of the American people. This second point is illustrated better in today’s Part III information.

Chris Jacobs, writing in The Wall Street Journal, tells us Medicaid expanded during the Covid pandemic as a temporary response to this health crisis. Medicaid eligibility was expanded to allow people to access healthcare during this crisis since many had lost their jobs. But the emergency ended in 2023, yet the Biden Administration prolonged the declared emergency allowing millions of more Americans to enroll in Medicaid who were not previously eligible due to their higher income status.

In January, 2025, the Congressional Budget Office (under the Biden Administration) increased its projection for 2025 Medicaid enrollment by another 5 million people compared with its June 2024 baseline.

Jacobs says, “This enrollment rise was the largest factor in the CBO’s projected $817 billion jump in program spending over the coming decade. As Congress works to pass Medicaid reforms in budget reconciliation legislation, lawmakers can reverse this continual expansion of government coverage by enacting policies that promote private insurance options.”\

While Covid-era legislation helped get us where we are, it was ObamaCare’s expansion of Medicaid to able-bodied adults that kicked things off. Though the Affordable Care Act prohibited those with an offer of “affordable” employer coverage from qualifying for federally subsidized ObamaCare exchange plans, it had no such restrictions regarding its Medicaid expansion. Any enrollee in an expansion state who meets the law’s income criteria qualifies for coverage, giving households every incentive to drop their existing insurance and enroll in “free” Medicaid.

As a result, expanded Medicaid has crowded out private insurance options. A 2007 study co-authored by Jonathan Gruber, one of ObamaCare’s architects, found that coverage expansions had crowd-out rates of roughly 60%. A 2008 analysis by the Kaiser Family Foundation found that, even among households of modest means with incomes between one and two times the poverty level, 44% had private coverage, suggesting that Medicaid expansion would erode existing sources of insurance.

This exact scenario was demonstrated in Louisiana where Department of Health data showed that between 3,000 and 5,000 people a month dropped their private coverage during the initial months of the state’s Medicaid expansion. The numbers suggested that roughly a third of Medicaid enrollees had left their private coverage to join the government rolls.

This shift from private health insurance shifts the burden of providing healthcare from employers and individuals to the federal and state governments. Democrats favor this transfer of healthcare insurance from private to government because they favor total government control of healthcare – better known as socialized medicine.

But socialized medicine has been tried in many other countries, such as Great Britain, Canada, and Sweden with predictable results. In each of these countries, access to healthcare has declined as government controls that access with limited providers and resources. The government also rations healthcare by determining which procedures and medications you can get and which you can’t. If your diagnosis requires expensive treatments that don’t guarantee success, those treatments will probably not be approved. If you’re over a certain age you may not be approved for expensive procedures like heart bypass or joint replacement surgery All of which leads to diminished healthcare outcomes. We don’t want that in America.

Jacobs suggests, “Republicans in Congress can stop this unending welfare state bloat in the reconciliation process by mandating that states offer premium assistance and requiring qualifying Medicaid beneficiaries to use it. Rather than paying for everything Medicaid entails, premium assistance supplements employer coverage by helping a person pay for costs their private insurance doesn’t. If Congress did this, use of private insurance would expand.”

“Those beneficiaries who switch to premium assistance would gain more options. Private insurance generally offers higher physician reimbursements and broader access to care than Medicaid plans. Such a mandate would complement work requirements in Medicaid, by promoting a path to self-sufficiency and employer-based coverage rather than a life of dependency on the government. And requiring premium assistance would accomplish both objectives in ways that save taxpayers money.”

We must remember that expanding the rolls of Medicaid does not mean more Americans are getting better healthcare. Without access to good quality healthcare, a Medicaid card is nothing but a piece of paper.